assessing FASD in adolescents Leah 13 year old female Information from referral 13 year old Indigenous girl in OOHC Presented to ED with suicidal ideation Referred to CICADA for support with substance use ID: 1047873
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1. Understanding the journey of assessing FASD in adolescents
2. Leah13 year old female
3. Information from referral13 year old Indigenous girl in OOHC Presented to ED with suicidal ideationReferred to CICADA for support with substance use Key concerns:Mental health issuesBehavioural disturbanceCannabis use Disengagement from schoolJustice involvement
4. At the beginning…MH concernsBehavioural disturbanceSuicidal ideationSelf-harmPanic attacksReactive Attachment DisorderAttention problemsConduct Disorder and oppositional behaviour Drug and AlcoholSubstance use problems (cannabis) Child Protection Issues
5. The journey of engagement….Substance use problemsDaily cannabis – helped with sleep and anxietyExperimental methamphetamine – exacerbations in behaviour (including aggravated assault)Daily nicotineAvoided alcoholIn OOHCCarer challengesLiteracySingle-parent familyMental Health problemsComplex Early Life TraumaAuditory hallucinations during cannabis intoxication; concerns around early psychosisPsychiatry review- Diagnosis of Mild Early SchizophreniaSchool DisengagementLearning and behaviour
6. Challenges on the journey…Appointments were often crisis oriented
7. Parental Substance Use Suspected PAE
8. Vulnerable GroupsYoung people with:intellectual disability*parental substance abuse*complex trauma background*out of home care*juvenile justice involvement*co-morbid mental health* Ref: Lede MA et al. The consequences of chronic cannabis smoking in vulnerable adolescents. Paediatr Respir. Rev. (2016)
9. Vulnerable GroupsYoung people with:intellectual disability*parental substance abuse*complex trauma background*out of home care*juvenile justice involvement*co-morbid mental health* Ref: Lede MA et al. The consequences of chronic cannabis smoking in vulnerable adolescents. Paediatr Respir. Rev. (2016)FASD
10. FASD assessmentKey criteria
11. Key criteria
12. Prenatal alcohol exposure
13. History Multiple sourcesFACSCourt reportsHealth recordsAUDIT-C Confirmed episodes of heavy alcohol use Birth mother had alcohol dependency and alcohol related injury and related offences Removed from care at 4 months of age due to maternal AOD use, domestic violence and neglect
14. Neurodevelopment & Mental health
15. NEURODEVELOPMENTAL DOMAINS
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18. NEURODEVELOPMENTAL DOMAINS
19. Physical assessment
20. Face, microcephaly, growth – biomarkers for PAE
21. Face, microcephaly, growth – biomarkers for PAESPECIFICITY – > 95%all 3 features = 1st trimester PAE Typical in FASDNot specific in isolationPrevalent in FASD Esp. short statureHigher CNS risk
22. Physical Assessment Sentinel Facial Features Palpebral fissure length: within normal range Lip thinness was Rank 4 (Caucasian Philtrum chart) and Rank 5 (African-American chart) (1 sentinel facial feature of FASD) Normal HC and growth parameters
23. FASD assessmentKey criteria
24. Neurocognitive Understanding of FASDSource: Jodee Kulp http://www.betterendings.org
25. Strengths Strong attachment with foster father Improving school attendance with support Juvenile Justice no longer involved Connected with friends Creative Enjoys engaging in Aboriginal cultureInterested in hearing about cultureLinked in with Aboriginal elder through local serviceAttending Aboriginal dance class
26. Why diagnose?Benefits for Leah (the adolescent) Enhanced understanding of their strengths and needs Understanding ‘cause’ Reframe behaviour – “will not” vs. “cannot” Better targeted support and early intervention Parents can be connected with appropriate supports Assistance for NDIS funding and transition planning Prevention
27. The journey in assessing FASD in adolescents
28. If you want to learn more...FASD HUBhttps://www.fasdhub.org.auThis website provides information on FASD for health professionals, parents and carers, other professionals (including for justice, education, child protection and disability services), researchers and policy makers. NOFASDhttps://www.nofasd.org.au NOFASD Australia is a non-profit charitable organisation and the peak organisation representing the interests of individuals and families living with FASD.
29. Telethon Kids Institutehttps://alcoholpregnancy.telethonkids.org.au/resources/health-professionals/An Australian research institute focused on discovering causes, cures and treatments for the illnesses and diseases that target our kids and young people. The Telethon Kids Institute provides extensive information on the latest research in FASD and has developed a research subsite (see second link) specifically addressing Alcohol, Pregnancy, and FASD. E-Learning Modules: https://alcoholpregnancy.telethonkids.org.au/alcohol-pregnancy-and-breastfeeding/diagnosing-fasd/e-learning-modules/